Welcome to the ECIM 2021 Virtual Congress Programme Scheduling

Background and Aims

BACKGROUND: Rheumatoid arthritis (RA) can be associated with bronchiectasis (BQ). The mechanism underlying this association remains unknown. We aimed to characterize the patients with RA and BQ and in particular the relevance of the presence of antibodies to citrullinated protein antigens (ACPA).

Methods

METHODS: We conducted a retrospective, case-control study, including baseline data from 80 patients with diagnosis of RA that were in hospital clinical records from January 2018 to December 2019. 20 patients with RA and BQ were selected and 60 controls were randomized.

Results

RESULTS: The mean age was 65±11 years; there was a predominance of female (71%) patients. Mean age of diagnosis of RA was 55±13 years and the mean age of diagnosis of BQ was 71±9 years. There was a significant association between the presence of ACPA and BQ (p =0.001). 13% of all patients had respiratory infections; there was an association with biologic treatment (p=0.0034) but there was no association between the presence of BQ and respiratory infections (p=0.258).

Conclusions

CONCLUSIONS: The diagnosis of BQ occurred, in mean, 16 years later after the diagnosis of RA. The presence of ACPA was related with the development of BQ. In patients with BQ, the prevalence of respiratory infections was not increased.

Background and Aims

Cardiovascular risk is increased in giant cell arteritis (GCA). We aimed to characterize myocardial infarction (MI) in a GCA cohort, and to compare the GCA and non-GCA population affected by MI.

Methods

In patients with a biopsy-proven diagnosis of GCA between 1 January 2001 and 31 December 2016 in Côte D’Or (France), we identified patients with MI by crossing data from the territorial myocardial infarction registry (Observatoire des Infarctus de Côte d’Or, RICO) database. Five controls (non-GCA + MI) were paired with one case (GCA + MI) after matching for age, sex, cardiovascular risk factors and prior cardiovascular disease. MI were characterized as type 1 MI (T1MI), resulting from thrombus formation due to atherothrombotic disease, or type 2 MI (T2MI), due to a myocardial supply/demand mismatch. GCA-related MI was defined as MI occurring within 3 months of a GCA flare (before or after).

Results

Among 251 biopsy-proven GCA patients, 13 MI cases were identified and paired with 65 controls. MI was GCA-related in 6/13 cases, accounting for 2.4% (6/251) of our cohort. T2MI was more frequently GCA-related than GCA-unrelated (80% vs. 16.7%, p=0.080), and vasculitis was the only triggering factor in 75% of GCA‑related T2MI. GCA-unrelated MI were more frequently T1MI and occurred in patients who had received a higher cumulative dose of prednisone (p=0.032). GCA was not associated with poorer one-year survival.

Conclusions

GCA-related MI are mainly T2MI probably caused by systemic inflammation rather than coronaritis. GCA‑unrelated MI are predominantly T1MI associated with atherothrombotic coronary artery disease.

Background and Aims

As of October 2020, Coronavirus Disease 2019 (COVID 19) has infected more than 368,000 people in the Philippines. Although no study has been done on malnutrition and COVID 19, it has long been associated with poor long-term outcomes. We aimed to determine the prevalence and associated factors of malnutrition among patients with COVID 19.

Methods

A cross-sectional study on COVID 19-confirmed patients admitted to the wards from July 15 to September 15, 2020. Nutritional status was assessed using the Philippine Society for Parenteral and Enteral Nutrition modified Subjective Global Assessment Grade (SGA) tool. Chi-square test or Fisher exact test, as appropriate, was used to identify factors that have a significant association with malnutrition. Furthermore, logistic regression was done on factors with a significant association.

Results

Among the 355 patients in the study, 71.83% (255) were malnourished. Factors significantly associated with malnutrition: community-acquired pneumonia (CAP) [p-value < 0.001], hospital-acquired pneumonia (HAP) [p-value 0.002], and chronic kidney disease (p-value 0.033). Multivariable logistic regression revealed that age [OR 1.02, CI 95% 1.00, 1.04, p-value 0.027] and CAP-MR [OR 3.02, CI 95% 1.73, 5.27, p-value < 0.001] are significant predictors of malnutrition. All patients with CAP- High Risk and HAP were predicted perfectly to be malnourished.

Conclusions

The prevalence of malnutrition was high (71.83%) in a general cohort of COVID 19 patients using the modified SGA. Risk factors of malnutrition among patients with COVID 19: age, CAP, and HAP. Nutritional support and management of comorbidities are of paramount importance in the care of patients with COVID 19.

Background and Aims

A high Neutrophil to Lymphocyte Ratio (NLR) is considered an unfavorable prognostic factor in various diseases, including COVID-19. The prognostic value of NLR in other respiratory viral infections, such as Influenza, has not hitherto been extensively studied. We aimed to compare the prognostic value of NLR in COVID-19, Influenza and Respiratory Syncytial Virus infection (RSV).

Methods

A retrospective cohort of COVID-19, Influenza and RSV patients admitted to the Tel Aviv Medical Center from January 2010 to October 2020 was analyzed. Laboratory, demographic, and clinical parameters were collected. Two way analyses of variance (ANOVA) was used to compare the association between NLR values and poor outcomes among the three groups. ROC curve analyses for each virus was applied to test the discrimination ability of NLR.

Results

722 COVID-19, 2213 influenza and 482 RSV patients were included. Above the age of 50, NLR at admission was significantly lower among COVID-19 patients (P<0.001). NLR was associated with poor clinical outcome only in the COVID-19 group. ROC curve analysis was performed; the area under curve of poor outcomes for COVID-19 was 0.643, compared with 0.497 and 0.537 for Influenza and RSV respectively. In the COVID-19 group, multivariate logistic regression identified a high NLR (defined as a value above 4.7) to be a prognostic factor for poor clinical outcome, after adjusting for age, sex and Charlson comorbidity score (odds ratio of 1.6, P=0.005).

Conclusions

NLR at admission is lower and has more prognostic value in COVID-19 patients, when compared to Influenza and RSV.

Background and Aims

The effect of the COVID-19 pandemic on the hospitalization outcomes of non-COVID-19 patients is not known.

Methods

We conducted a retrospective analysis of characteristics and hospitalization outcomes of patients hospitalized at Shamir medical center between March 19^th, 2019 to April 16^th, 2019, and during the first COVID-19 lockdown from March 19^th, 2020 to April 16^th, 2020.

Results

During the lockdown, 544 non-COVID patients were hospitalized in internal medicine wards compared with 903 patients in the same period the previous year. During the lockdown, hospitalized patients came more often from long-term facilities and were more frequently dependent. Also, patients of the 2020 period had a higher Charlson mortality index score. The cause of admission was significantly more often infectious (mainly pneumonia). Length of hospitalization was significantly shorter. Interestingly, admission during lockdown was independently associated with in-hospital, 30 and 90 days mortality; adjusted odds ratio (aOR) for in-hospital mortality was 1.57 (95%CI 1.059-2.339 p=0.025), aOR for 30 days mortality was 1.64 (95%CI 1.12-2.41 p=0.011) and aOR for 90 days mortality was 1.5 (95%CI 1.073-2.12 p=0.018).

Conclusions

A substantial decrease in non-COVID-19 hospitalizations to internal medicine departments was found during the lockdown. Significant differences in baseline characteristics cause for admission and length of hospitalization were noted. Hospitalization during the lockdown was independently associated with an increase in short-term mortality. Due to the lack of studies examining out-of-hospital mortality, it is hard to conclude the reasons for these findings. Studies should further investigate the effect of the pandemic on the non-COVID population.

Background and Aims

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has become pandemic. A minority of patients exhibit an aberrant and excessive immune reaction, defined as cytokine release syndrome (CRS). As CRS is a major cause of disease severity and death, more information on the composition and activity of the T cell compartment is necessary.

Methods

We profiled the T cell composition, activation, and proliferation in patients with severe or critical COVID-19 and matched healthy controls by flow cytometry. 20 hospitalized COVID-19 patients, eight severe and twelve critical cases, were included. In addition, two healthy controls were age- and sex-matched to each COVID-19 patient.

Results

Beside lymphopenia we identified: reduced CXCR3⁺CCR4^-CCR6^- Th1 cell frequencies in critical COVID19 cases, elevated CXCR3^-CCR6⁺ Th17 cells in both severe and critical, and higher CD8⁺ T cell frequencies in the severe group. Furthermore, frequencies of CD4⁺ central memory and CD8⁺CD28^- differed significantly between healthy and SARS-COV-2 infected subjects. Compared to healthy controls patients suffering from severe COVID-19 had increased frequencies of activated and proliferating CD38⁺Ki67⁺ Th1 and CD8⁺ T cells suggesting active anti-viral T cell defense. In contrast, the frequencies of CD38⁺Ki67⁺ Th1 and CD8⁺ T cells correlated negatively with increasing plasma IL-6 in COVID-19 CRS.

Conclusions

Our data suggest that SARS-CoV-2-induced CRS may impair viral clearance by blunting the antiviral T-cell response.

Background and Aims

Giant cell arteritis (GCA) is a medical emergency. Ultrasound (US) halo sign is useful in diagnosing GCA. We propose a novel ultrasound Halo Score (HS) as a potential marker to diagnose and assess disease activity in GCA patients.

Methods

Prospective multicentre study (HAS GCA) including 80 suspected GCA patients from fast track referrals at baseline and 3 months follow-up. Southend pre-test probability score stratified patients to Low, Intermediate, High-risk. HS calculated from intimal medial thickness in bilateral temporal artery branches (TAHS) and axillary arteries (AAHS), summed a Total Halo Score (THS). GCA diagnosis; clinical, positive US/additional test with CRP >5 mg/dl

Results

Twenty-seven (34%) confirmed GCA, 53 (66%) non-GCA (controls), median age 72.0 in GCA, 52% females in GCA and 70% controls. GCA and controls stratification Low (0% vs 100%), Intermediate (24% vs 76%), High risk (71% vs 29%). Jaw-claudication, polymyalgia in GCA (63% and 56%) versus controls (3% and 8%), prior vision loss 22% GCA versus 4 % controls. 38% controls on glucocorticoids (GC) at presentation. 3-month median cumulative GC dose in GCA 2875 grams

US had a high sensitivity (96%), specificity (98%) and accuracy (98%) in diagnosing GCA. 63% (17) GCA have completed 3 months follow up. Baseline median THS in GCA and control was 21 and 4 respectively (p=0.0001). 3-month median TAHS, AAHS and THS reduced from 10 to 3, 12 to 6 and 21 to 10.

Conclusions

Southend HS successfully discriminates GCA from non GCA mimics, quantifies vascular inflammation and helps assessing response in GCA.

Background and Aims

The breadth of the humoral immune response following SARS-CoV-2 infection was indicated to be important for recovery from COVID-19. However, the information regarding the temporal dynamics of the serological and cellular memory in COVID-19 recovered patients is scarce.

Methods

We analyzed the temporal dynamics of SARS-CoV-2 specific antibodies and B cells in 60 COVID-19 recovered patients using ELISA, in-vitro neutralization assay, flow cytometry, and Next-Generation Sequencing of the B cell receptor antibody variable genes.

Results

We found that acute phase SARS-CoV-2 patients mount a rapid, robust antibody response following infection however, the serological memory decays in COVID-19 recovered patients over the period of six months. Using an in vitro neutralization assay revealed a strong correlation between total RBD-specific (RBD⁺) antibodies and neutralizing antibodies suggesting that antibody levels can be used as a proxy to determine neutralizing capacity. In contrast to the observed antibody decay, the memory B cell frequency was found to be stable over time. Next-generation sequencing of viral-specific B cell receptors showed an unregular high frequency of the IgG4 isotype which is known to contribute to the manifestation of IgG4 related disease and other autoimmune diseases specifically, IgG-related lung disease.

Conclusions

The persistence of viral-specific memory B cells following recovery may contribute to a robust recall humoral response in a case of re-infection by SARS-CoV-2. Interestingly, the repertoire analysis of viral-specific B cell response suggests that the induction of IgG4 may promote COVID-19 severity and could explain the long-term outcome in some COVID-19 recovered patients.

Background and Aims

Remdesivir is FDA/EMA approved for the treatment of hospitalized COVID-19 patients and was shown to shorten time to recovery in RCTs. Real-world evidence for RDV utilization is sparse.

Methods

This retrospective study included adult COVID-19 US hospitalized patients (May-November-2020). Descriptive analyses of timing of RDV initiation, severity (oxygenation level) over time, in-hospital mortality by timing of RDV initiation, and overall mortality and ICU use are reported.

Results

Of the 190,529 patients hospitalized for COVID-19, 55,030 (29%) were treated with RDV. RDV patients had a mean age of 64 years, 69% were White, 15% Black, and 56% male.

From May to November, overall RDV utilization increased from 5% to 47%, while initiation of RDV on day 1 or 2 of the hospitalization increased from 40% to 85%. Similar trends were observed with steroid use.

In May, 68% of RDV patients were on low-flow or no oxygen at the time of RDV initiation, which increased to 86% in November.

Mortality was 12% for patients starting RDV on day 1/2 and 29% for patients starting after day 5 of hospitalization. Concurrently, ICU use decreased from 33% to 22% and overall mortality decreased from 14% to 9% over time.

Conclusions

Earlier use of RDV and in less severe patients was evident in the cohort over time, consistent with populations shown to have benefited in RCTs. While improvement in mortality and morbidity is clearly multifactorial, the changes in use of RDV towards patients more likely to derive benefits may have contributed to the overall trends.